Unit-based Hazard Assessment
for Safe Patient Handling
1
Unit-based Hazard Assessment for
Safe Patient Handling
Mary Willa Matz, MSPH
VHA Patient Care Ergonomics Program Manager/Consultant
Occupational Health Science Researcher
Industrial Hygienist
VISN 8 Patient Safety Center of Inquiry
James A. Haley VA Hospital
Tampa, Florida
(813) 558-3928 (813) 558-3990 fax
mary.matz@va.gov
2
Faculty Disclosure

Ms. Matz does not endorse any specific vendor or
manufacturer of patient handling equipment or
devices.

Ms. Matz has no financial relationships or interests
with any commercial topics that are discussed in this
activity.

This activity includes no discussion of uses of FDA
regulated drugs or medical devices which are
experimental or off-label.

The opinions expressed in this presentation are the
opinions of Ms. Matz, and do not represent the
views/opinions of the Veterans Health Administration.
3
Ergonomics
and
Patient Handling
4
Ergonomics…
"Ergonomics is the scientific study of the
relation between people and their…
Occupation
 Equipment
 Environment“

(Shackel)
5
Ergonomics Principles
• Design for human use
• Fits the task to the worker
• People are different
• People have limitations
• People age
6
An Ergonomic Approach…
Provides a step-by-step process
to ensure the appropriate
technology is in place to
reduce musculoskeletal stress
& strain…. reducing the risk
of injury.
7
A Simple Look at an
Ergonomic Approach
Tasks:

Identify jobs and job tasks which stress body
parts beyond limits

Develop solutions to change these task demands.
Workplace Environment:

Review the design of the physical work
environment to reduce risk, remove barriers,
minimize travel, etc.
Other Factors:

Consider other factors that affect work
performance, such as lighting, noise, equipment
storage & maintenance issues.
Implement these changes in the work place.
8
ERGO INJURY TRIANGLE
Force
Injury
Posture
Frequency
/Duration
9
Ergonomic Hazards
What are Ergonomic Hazards?
Musculoskeletal System
 Energy/Forces/Stressors
 Exceed the biomechanical limits of the
human body

10
What Do “Patient Care” Ergonomic
Hazards result from?
Patient lifting and moving exceed
caregivers’ biomechanical
limits…
11
What Do “Patient Care” Ergonomic
Hazards result from?

Ergonomic hazards for caregivers include…









pushing, pulling
lifting heavy loads
horizontal & vertical lifting
lifting light loads for long periods of time
twisting, bending, reaching
standing for long periods of time
awkward postures
repetitive motions
others….
12
What Do “Patient Care” Ergonomic
Hazards result from?

“Safe” lifting rules don’t apply
(Horizontal and vertical lifting)

Patients:
 are
asymmetric & bulky
 can’t be held close to the body
 have no handles

Patient assistance varies
13
What Do “Patient Care” Ergonomic
Hazards result from?

Patient care is unpredictable due to
unanticipated patient responses…


muscle spasms, combativeness, or resistance
Results in…


Unexpectedly heavy loads
Patient Movement
 When lifting/handling a moving object,
loading/stress on the spine increases
beyond what it would be for a slow, smooth
lift of a stable object.
14
Simple Biomechanical
Model
F=ma
d
Work = Force x Distance
15
W=Fxd
Exceeding Biomechanical Capabilities
results in…
Musculoskeletal impact/stress on…
 Back
 Shoulders
 Neck
 Wrist
 Hand
 Knees
 Other
body parts…
16
Example 1: Pull up in Geri-Chair
Risk Factor:
•Manual Lifting
Body Parts Affected:
• Back – posture, load/force
• Shoulder – load/force
• Elbow – load/force
• Wrist/hand – load/force
• Neck – load/force
Interventions:
 Sit to Stand Lifts
 Ceiling/Floor Full Body Sling Lifts
 Friction Reducing Devices
17
Example 2: Transfer to Stretcher
Risk Factor:
•Manual Lifting
Body Parts Affected:
• Back – posture, load/force
• Shoulder – load/force
• Elbow/Wrist/Hand – load/force
• Neck – load/force
Interventions:
•Ceiling/Floor Full Body Sling Lifts
•Lateral Transfer Devices (LTD)
•Friction reducing devices
•Air Assisted LTD
•Mechanical LTD
18
Example 3: Transfer from Chair
of partial weight-bearing patient
Risk Factor:
•Manual Lifting
Body Parts Affected:
• Back – posture, load/force
• Neck – load/force
• Shoulder – load/force
• Elbow – load/force
• Wrist/hand – load/force
Intervention:
•Sit to Stand Lift
19
Example 4: Lateral Transfer
Risk Factor:
•Space Constraints
Body Parts Affected:
• Shoulder – posture/load
• Elbow – position/load
• Wrist/hand – position/load
• Neck – posture/load
• Back – posture/load
Intervention:
•Ceiling Lift
•Renovate room
20
Unit-Based Hazard Assessment for
Safe Patient Handling
21
Unit-based Hazard Assessment for
Safe Patient Handling
‘Patient Care’ Practice Settings include…
•
ALL practice settings that move and lift patients
NURSING
•Acute Care
•Long Term Care
•Critical Care
•OR
•ER
•SCI
•Others…
NON-NURSING
•PT
•Diagnostics
•Treatment Areas
•Procedure Areas
•Morgue
•Dialysis
•Others..
22
Unit-Based Hazard Assessment
Role

Drives UNIT recommendations for
equipment, policy, and procedures

Identifies areas in need of improvement
that impact safety of work environment &
use of equipment
 Storage, maintenance, clutter, etc.
23
Unit-Based Hazard Assessment
I. Prior to Ergo Evaluation
– Data Collection
1.
2.
3.
Identify UNIT High Risk
Tasks
 Staff Perception of High
Risk Tasks
 Unit Injury data
Identify High Risk Units
Collect Information on
Unit Characteristics/Issues
II. During Ergo Evaluation
1.
2.
3.
Meet with Mgmt/Staff
Conduct Site Visit
Meet with Mgmt/Staff
III. After Ergo Evaluation
1.
2.
Perform Risk Analysis
Formulate
Recommendations
24
Unit-Based Hazard Assessment
I. Prior to Ergo Evaluation – Data Collection
1.
Identify UNIT High Risk Tasks


2.
3.
Staff Perception of High Risk Tasks
Unit Injury data
Identify High Risk Units
Collect Information on Unit
Characteristics/Issues
25
I. Prior to Ergo Evaluation
1. Identify High Risk Tasks
Collect Staff Perceptions of Unit High-Risk Tasks
‘Tool for Prioritizing High Risk Tasks’

Rank Tasks from 1 to 10
10 = most difficult/highest risk
1 = least difficult/ lowest risk

When ranking, consider:


Completed by



Musculoskeletal Stress = Load, Posture, Frequency/Duration
Each Staff member
Collectively by Shift
Compile by Unit and Shift
26
I. Prior to Ergo Evaluation
1. Identify Unit High Risk Tasks
Collect Unit Injury Data
PATIENT CARE INCIDENT/INJURY PROFILE
Patient Care
Activity
Cause of
Injury
Sample:
Patient transfer
bed to
stretcher
Reaching
across
stretcher
for patient
Type of
Injury
Strain
Body
Part(s)
Location
Upper back Patient
bedside
Time of
Injury
09:30
Lost
Days
3
*Be sure to note which source is used on your Injury Log
Modified
Duty
Days
5
27
I. Prior to Ergo Evaluation
2. Identify High Risk Units
Beware of using Injury data….
28
I. Prior to Ergo Evaluation
2. Identify High Risk Units
Directs focus for equipment and policy interventions
 Identification of High Risk Units
 Analyze all facility UNIT injury data…
Highest number of patient handling injuries
 Most severe patient handling injuries




Lost Time
Modified Duty
High Risk Unit Characteristics



Many dependent patients/residents
Patients are moved in and out of bed often
Many patient transfers
29
I. Prior to Ergo Evaluation
3. Collect Pre-Site Visit Unit Data
Use ‘Unit Characteristics/Issues’ Tool (Handout A-1)
 Space issues
 Storage availability
 Maintenance/repair issues
 Patient population (% dependency*)
 Staffing characteristics
 Equipment inventory/issues


Confirms site visit data
Used for making recommendations
30
Unit-Based Hazard Assessment
II. During Ergo Evaluation/Site Visit
1.
2.
3.
Opening Meeting
Site Visit/Walk-through
Closing Meeting (optional for unit, required for
administration)
31
II. During Ergo Evaluation/Site Visit
1. Conduct Opening Meeting

Discuss



Pre-Site Visit Data
Issues of Concern
Include






Staff
Unit/Area Manager
Safety/Risk Management
Facilities Management
Union
Others
32
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
During Site Visit Walk-through, interview
staff…
 Confirms
Pre-Site Visit Unit Data Collected
 Discovers staff attitudes, concerns, ideas,
information
33
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
During Site Visit Walk-through, observe…
 Equipment
 Availability
 Accessibility
 Use
 Condition
 Storage
 Structural
issues that impact use
34
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
During Site Visit Walk-through, note…
 Patient
room sizes/configurations
 Ceiling Characteristics/AC vents/TVs/Sprinklers
 Showering/bathing facilities & process
 Toileting process
 Safety Design Issues: Thresholds, Doorways
 Storage
35
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
During Site Visit Walk-through, document…
Existing/ordered patient handling equipment
 Occurrence of high risk tasks
 % total dependent & extensive assistance pts
 % partial assistance patients
 Occurrence of bariatric/obese patients
 Room configurations
 # beds on unit/average daily census
 Storage issues
 Equipment/Sling recommendations
 Notes
(Sample PCE Templates - Handouts A-2a & A-2b)

36
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage
Based on…
1.
2.
Dependency Level of patient/resident population
Room configurations on unit: # of private, semiprivate, 3-bed, 4-bed rooms, etc. on unit.
37
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage
Limitations…
1.
2.
3.
4.
5.
6.
Structural integrity of mounting surface (I-beam/
concrete pan)
Ceiling fixtures - lights, sprinkler heads, AC vents, etc.
Ceiling Height
Ceiling configuration/drop ceiling/AC housing
ICU Power Columns
Others
38
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Track Options
Traverse
Straight
(x-y or H)
Curved
U-shaped
39
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…
1.
Determine Average % of Patients Requiring
Ceiling Lift (CL) System Coverage:

Sum average % of


total dependent patients
extensive assistance patients/residents
40
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…
2. Determine # & Configuration of Rooms
requiring Ceiling Lift Systems per unit:

To calculate number of rooms needing ceiling
lifts, use Average % of Patients requiring CL
Coverage (Previous slide)
41
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…

For units w/ only private patient rooms:


Average % of Patients Requiring CLs
= # private patient rooms w/ CLs
x # patients
For units w/ only semi-private rooms:

Average % of Patients Requiring CLs x # patients / 2
= # semi-private patient rooms w/ CLs
42
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…
For units with a mixture of room configurations:

For cost effectiveness in existing construction, and if
appropriate for the unit…
 First begin calculations with ceiling lifts placed in most
or all larger wards (3-bed & 4-bed wards)
 Then, as appropriate, place in smaller rooms (private
and semi-private)
43
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage continued…
Example:

MedSurg Unit




30 patients
4 private rooms, 10 semi-private rooms, and two 3-bed rooms.
Approximately 70% of the patients will require use of Ceiling
Lifts; therefore this unit should have coverage for 21 patients
(70% x 30 patients).
For cost effectiveness, and if appropriate for unit needs,
to provide 70% ceiling lift coverage, include in...



two (2) 3-bed rooms (covering 6 patients)
seven (7) semi-private rooms (covering 14 patients)
one (1) private room (covering one patient)
44
II. During Ergo Evaluation/Site Visit
2. Conduct Site Visit
Unit Ceiling Lift System Coverage Practice
(Handout A- 3)



1.
2.
3.
NHCU Unit
Med/Surg (Tele) Unit
Med/Surg (Rehab) Unit
How many (#) patients/beds should be covered?
In what rooms would you place ceiling lifts on this
unit?
How many ceiling lifts would you purchase/install for
this unit?
45
II. During Ergo Evaluation/Site Visit
3. Conduct UNIT Closing Meeting (optional)

Discuss




Preliminary Findings
from Site Visit
Pre-Site Visit Data as
related to findings
Priorities in need of
immediate
remediation
Issues of Concern

Include






Staff
Unit/Area Manager
Safety/Risk
Management
Facilities Management
Union
Others
46
II. During Ergo Evaluation/Site Visit
3. Conduct ADMINISTRATOR Closing Mtg

Discuss





Rationale for Site Visit
Preliminary Findings from
Site Visit
Priorities in need of
immediate remediation
Issues of Concern
Show photos of equipment
recommendations

Include







Staff
Union
Unit/Area Managers
Safety/Risk
Management/Employee
Health
Facilities Management
CFO/Purchasing
Others
47
Unit-Based Hazard Assessment
III. After Ergo Evaluation
1. Perform Risk Analysis
2. Generate Recommendations
48
III. After Ergo Evaluation
1. Perform Risk Analysis
Sources of Risk:

You must know the SOURCES of risk in
your patient care environment to perform
Risk Analyses…
49
Sources of Risk
Risk Sources:



Health Care Environment
Patient
Patient Handling Tasks
Once risks are identified, steps can be taken to protect
Staff and Patients!
50
What’s Wrong with this Picture??
51
Sources of Risk
Health Care Environment Risk Factors


Space limitations
 Small rooms
 Lots of equipment
 Clutter
 Cramped working space
Poor placement of room furnishings
52
Sources of Risk
Health Care Environment Risk Factors
Slip, trip, and fall hazards
 Uneven work surfaces (stretchers, beds, chairs,
toilets at different heights)
 Uneven Floor Surfaces (thresholds)
 Narrow Doorways
 Poor bathing area design

53
Sources of Risk
Health Care Environment Risk Factors
Broken Equipment
 Inefficient Equipment (non-electric, slowmoving, bed rails)
 Not enough or Inconvenient Storage Space
 Staff who don’t help each other or don’t
communicate

54
What’s Wrong with this Picture??
55
Sources of Risk
Patient Risk Factors
Weak/unable to help with
transfers
 Unpredictable
 Hit or bite
 Resistive Behavior
 Unable to follow simple
directions

56
Sources of Risk
Patient Risk Factors
 Overweight
 Experiencing Pain
 Hearing or vision loss
 No/little communication
between staff about Patient
or with Patient
57
What’s Wrong with this Picture??
58
Sources of Risk
Patient Handling Tasks Risk Factors






Reaching and lifting with loads far from the body
Lifting heavy loads
Twisting while lifting
Unexpected changes in load
demand during lift
Reaching
Long Duration
59
Sources of Risk
Patient Handling Tasks Risk Factors





Moving or carrying a load
a significant distance
Awkward Posture
Pushing/Pulling
Completing activity with
bed at wrong height
Frequent/repeated
lifting & moving
60
III. After Ergo Evaluation
1. Perform Risk Analysis
High Risk Task Identification:

To determine the risk of injury for each
unit/patient population, high risk tasks specific
to the unit must be identified…
61
III. After Ergo Evaluation
1. Perform Risk Analysis
Identify UNIT high risk tasks by…
1. Analyzing Unit Injury Data
2. Collecting Staff Perception of High Risk
Tasks
3. Interviewing Employees
62
III. After Ergo Evaluation
1. Perform Risk Analysis
1. Analyze Unit Injury Data
Determine:
 #1
& 2 Causes of Injuries
 #1 & 2 Activities being performed when staff
are injured
 What’s going on? What trends are seen?
’Injury Incidence Profile’ (Handout A-4)
63
III. After Ergo Evaluation
1. Perform Risk Analysis
2. Complete & Collate Staff Responses for ‘Tool for
Prioritizing High Risk Tasks’ (Handout A-5)

Rank Tasks from 1 to 10
10= most difficult/highest risk
1 = least difficult/ lowest risk

When ranking, consider:


Completed by



Frequency, Duration, & Musculoskeletal Stress
Each Staff member
Collectively by Shift
Compile by Unit and Shift
64
III. After Ergo Evaluation
1. Perform Risk Analysis
High Risk Tasks will vary by
Clinical Setting….
65
High Risk Tasks:
Long Term Care








Repositioning in Bed*
Making occupied bed*
Transferring patient from
bathtub to chair*
Transferring patient from
wheelchair to bed*
Transferring patient from
wheelchair to toilet*
Lifting a patient up from
the floor*
Weighing a patient*
Applying antiembolism
stockings
* Lifts







** Bed mover or powered bed
Bathing a patient in bed*
Bathing a patient in a
shower chair /trolley*
Undressing/dressing a
patient*
Repositioning patient in
dependency chair* **
Making an occupied bed*
Feeding bed-ridden
patient
Changing absorbent pad*
*** Lateral transfer aid (FRD)
66
High Risk Tasks:
Critical Care Units








Transporting patients (Road Trips)**
Lateral Transfers (bed to stretcher)* ***
Repositioning patient in bed from side
to side* ***
Vertical Transfers (bed/chair/commode)*
Lifting patient to the head of the bed* ***
Making occupied bed* ***
Applying antiembolism stockings
Bending/Reaching behind & around
for equipment, etc.
* Lifts
** Bed mover or powered bed
*** Lateral transfer aid (FRD)
67
High Risk Tasks:
Medical/Surgical Units





Transfer from bed to
chair*
Transfer from bed to
stretcher* ***
Moving Occupied bed
or stretcher**
Making occupied bed*
***
Bathing a confused or
totally dependent
patient
* Lifts






** Bed mover or powered bed
Lifting a patient up from
the floor*
Weighing a patient*
Applying antiembolism
stockings
Repositioning in bed* ***
Making occupied bed* ***
Extensive dressing
changes*
*** Lateral transfer aid (FRD)
68
High Risk Tasks:
Operating Room




Standing long periods
of time
Lifting and holding
patient’s extremities*
Holding
retractors/organs for
long periods of time
Transferring patients
on and off operating
room tables/beds* ***
** Bed mover or powered bed
•*** Lateral transfer aid (FRD)



Reaching, lifting and
moving equipment
Repositioning patients
on operating room
beds* ***
Reaching for
equipment
•Lifts
69
High Risk Tasks:
Orthopedic Units









Post-operative Total Hip Replacement Patient
Patient with a cast/splint on extremity
Use of Continuous Passive Motion Device
(CPM)
Halo Vest, logrolling for dressing changes
Holding Extremity for procedure
Altered Gait Pattern - Platform Walker
Assembling Traction
Transfers In/Out a Car
Transfers of Patients with Pelvic & External
Fixators
70
High Risk Tasks:
Home Settings




Providing patient care in a
bed that is not height
adjustable
Providing care in crowded
area, forcing awkward
positions
Toileting and transfer
tasks without proper
lifting aids
No assistance for tasks
71
High Risk Tasks: Psychiatry







Restraining a patient
Escorting a confused or
combative patient
Toileting a confused or
combative patient
Dressing a confused or
combative patient
Picking a patient up from floor
Bathing/ Showering confused
or combative patient
Bed-related care
72
Other High Risk Tasks
• Lifting heavy
linen bags
• Standing for long
periods of time
behind med carts
• Data entry
• Others…
73
III. After Ergo Evaluation
2. Generate Recommendations
Information from Risk Analysis
drives formation of
Equipment Recommendations…
74
III. After Ergo Evaluation
2. Generate Recommendations






Patient Handling Equipment
for each unit/area
Storage
Design Features
Repair/Maintenance
Injury Reporting
Bariatric Programs

Equipment Support
Structures






Unit Peer Leaders
Facility Champions
Facility Safe Patient Handling
Team
Training
Knowledge Transfer
Mechanisms
Change Strategies
Sample Report - Handout A-7
75
Unit-based Hazard Assessments for
Safe Patient Handling
‘Patient Care’ Practice Settings include…
•
ALL practice settings that move and lift patients
NURSING
•Acute Care
•Long Term Care
•Critical Care
•OR
•ER
•SCI
•Others…
NON-NURSING
•PT
•Diagnostics
•Treatment Areas
•Procedure Areas
•Morgue
•Dialysis
•Others..
76
77